title: The impact of lymph node disease in extremity soft-tissue sarcomas: a population-based analysis.
abstract: BACKGROUND
  Because of the low incidence of regional lymph node metastasis, node-positive soft-tissue sarcoma patients remain poorly characterized. Our objective was to assess regional lymph node metastasis in extremity sarcoma patients using a large population database.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results database was queried for extremity sarcoma patients. Clinicopathologic data and outcomes were examined to evaluate the significance of regional lymph node metastasis.
  
  
  RESULTS
  Of 7,159 patients without distant metastasis, 64 patients had identified regional lymph node metastasis (.9%). Regional lymph node metastasis was associated with younger age, tumor grade, size, invasion, and tumor subtype. Excluding distant metastasis, lymph node status was the strongest prognostic factor (hazards ratio = 5.1, P < .001).
  
  
  CONCLUSIONS
  Isolated regional lymph node metastasis is rare in extremity sarcoma patients. However, in the absence of distant metastasis, lymph node status is the most important prognostic factor. The management of positive lymph nodes remains uncertain although diagnosing lymph node metastasis may identify early biologically aggressive disease.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical University of South Carolina, USA.
authors.forename: David
authors.initials: D
authors.lastname: Johannesmeyer
authors.forename: Valerie
authors.initials: V
authors.lastname: Smith
authors.forename: David J
authors.initials: DJ
authors.lastname: Cole
authors.forename: Nestor F
authors.initials: NF
authors.lastname: Esnaola
authors.forename: E Ramsay
authors.initials: ER
authors.lastname: Camp
mesh_terms: D005121:Extremities; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D018426:SEER Program; D012509:Sarcoma / Q000401:mortality / Q000473:pathology*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
keywords: Extremity; Lymph node; Prognosis; Sarcoma